scholarly journals Topical Microbicides in HIV Prevention: State of the Promise

2020 ◽  
Vol 71 (1) ◽  
pp. 361-377 ◽  
Author(s):  
Jared M. Baeten ◽  
Craig W. Hendrix ◽  
Sharon L. Hillier
Keyword(s):  
Hiv Prevention ◽  
Hiv Infections ◽  
Personal Control ◽  
Sexual Relationships ◽  
Ease Of Use ◽  
Topical Microbicides ◽  
Direct Acting ◽  
Exposure Prophylaxis ◽  
Anti Hiv ◽  
Clear Majority

HIV topical microbicides are products with anti-HIV activity, generally incorporating a direct-acting antiretroviral agent, that when applied to the vagina or rectum have the potential to prevent the sexual acquisition of HIV in women and men. Topical microbicides may meet the prevention needs of individuals and groups for whom oral daily forms of pre-exposure prophylaxis (PrEP) have not been acceptable. Microbicides can provide personal control over HIV prevention and offer the possibility of discreet use, qualities that may be particularly important for receptive partners in sexual relationships such as women and transgender women and men, who together account for the clear majority of new HIV infections worldwide. Although the promise of such a product emerged nearly three decades ago, proof of concept has been demonstrated only within the last decade. A robust pipeline of microbicidal gels, films, inserts, and rings has been evaluated in multiple studies among at-risk women and men, and refinement of products for ease of use, reversibility, and high safety is the priority for the field.

scholarly journals Women’s estimated HIV infections from sex in trials of pre-exposure prophylaxis in Africa: Implications for HIV prevention strategies

2017 ◽  
Author(s):  
David Gisselquist
Keyword(s):  
Hiv Prevention ◽  
Hiv Infections ◽  
Common Belief ◽  
Prevention Strategies ◽  
Sexual Risks ◽  
Hiv Prevention Strategies ◽  
Vaginal Gels ◽  
Vaginal Rings ◽  
Exposure Prophylaxis ◽  
Oral Prep

AbstractIntroductionDuring 2004-15, nine randomized controlled trials (RCT) for HIV prevention tested pre-exposure prophylaxis (PrEP) with oral drugs, vaginal gels, or vaginal rings among more than 17,000 women in Africa.MethodsThis study uses information from the nine RCTs to estimate the proportions of HIV from sexual and bloodborne risks, to consider reasons for success or failure with oral PrEP, and to consider risks with vaginal PrEP.ResultsEstimating from women’s reported frequencies of unprotected coital acts in six RCTs, only a minority of women’s infections came from sex. Oral PrEP may have succeeded in at least one trial by reducing infections from both bloodborne and sexual risks. Oral PrEP may have failed in several trials, at least in part, because some women used oral PrEP when they had sexual risks rather than daily as advised. Relatively high incidence with PrEP vaginal gels and rings vs. oral placebo suggests vaginal PrEP had little impact at best and may have been harmful.DiscussionEvidence from this and other studies challenges the common belief most HIV in Africa comes from sex. This challenge has implications for HIV prevention strategies, including: warning about bloodborne risks; and reconsidering PrEP for young women.

scholarly journals Integrating Pre-Exposure Prophylaxis Delivery in Public Health Family Planning Clinics: Lessons Learned From a Programmatic Implementation Project in Kenya

2021 ◽  
Vol 3 ◽  
Author(s):  
Kenneth K. Mugwanya ◽  
John Kinuthia
Keyword(s):  
Family Planning ◽  
Hiv Prevention ◽  
Implementation Strategies ◽  
Hiv Infections ◽  
Lessons Learned ◽  
African Women ◽  
Data Systems ◽  
Prep Implementation ◽  
Exposure Prophylaxis ◽  
Delivery Models

Sexually active African women are a priority population for HIV prevention due to the disproportionately high frequency of new HIV infections. Family planning (FP) clinics offer an already trusted platform that can be used to reach women for HIV prevention services, including pre-exposure prophylaxis (PrEP). In the recent PrEP Implementation in Young Women and Adolescent (PrIYA program), we piloted PrEP implementation in FP clinics in Kisumu, Kenya, and demonstrated that it was possible to integrate PrEP provision in FP systems with a program-dedicated staff. In this perspective, we describe experiences and strategies employed to introduce PrEP implementation in FP clinics and lessons learned. We identified the following lessons for PrEP introduction in FP clinics in Kenya: (1) possible to integrate and generate high enthusiasm for PrEP delivery in FP clinics but persistence on PrEP is a challenge, (2) involvement of national and regional stakeholders is critical for buy-in, contextualization, and sustainability, (3) delivery models that do not integrate fully with existing staff and systems are less sustainable, (4) creatinine testing at PrEP initiation may not be necessary, (5) fully integrated HIV and FP data systems need to be developed, and (6) incorporating implementation science evaluation is important to understand and document effective implementation strategies. In summary, integration of HIV prevention and FP services provides an opportunity to promote one-stop women-centered care efficiently. However, a broader focus on delivery models that utilize existing staff and novel strategies to help women identify their own risk for HIV are needed to ensure greater success and sustainability.

scholarly journals Pre-exposure prophylaxis rollout in a national public sector program: the Kenyan case study

Sexual Health ◽  
2018 ◽  
Vol 15 (6) ◽  
pp. 578 ◽  
Author(s):  
Sarah Masyuko ◽  
Irene Mukui ◽  
Olivia Njathi ◽  
Maureen Kimani ◽  
Patricia Oluoch ◽  
...  
Keyword(s):  
Public Sector ◽  
Hiv Prevention ◽  
Scale Up ◽  
Hiv Infections ◽  
Sub Saharan Africa ◽  
Health Providers ◽  
Middle Income ◽  
The Government ◽  
Exposure Prophylaxis

Background While advances have been made in HIV prevention and treatment, new HIV infections continue to occur. The introduction of pre-exposure prophylaxis (PrEP) as an additional HIV prevention option for those at high risk of HIV may change the landscape of the HIV epidemic, especially in sub-Saharan Africa, which bears the greatest HIV burden. Methods: This paper details Kenya’s experience of PrEP rollout as a national public sector program. The process of a national rollout of PrEP guidance, partnerships, challenges, lessons learnt and progress related to national scale up of PrEP in Kenya, as of 2018, is described. National rollout of PrEP was strongly lead by the government, and work was executed through a multidisciplinary, multi-organisation dedicated team. This required reviewing available evidence, providing guidance to health providers, integration into existing logistic and health information systems, robust communication and community engagement. Mapping of the response showed that subnational levels had existing infrastructure but required targeted resources to catalyse PrEP provision. Rollout scenarios were developed and adopted, with prioritisation of 19 counties focusing on high incidence area and high potential PrEP users to maximise impact and minimise costs. Results: PrEP is now offered in over 900 facilities countrywide. There are currently over 14000 PrEP users 1 year after launching PrEP.Conclusions: Kenya becomes the first African country to rollout PrEP as a national program, in the public sector. This case study will provide guidance for low- and middle-income countries planning the rollout of PrEP in response to both generalised and concentrated epidemics.

scholarly journals Putting the NHS England on trial: uncertainty-as-power, evidence and the controversy of PrEP in England

2020 ◽  
Vol 46 (3) ◽  
pp. 176-179 ◽  
Author(s):  
Maurice Nagington ◽  
Tony Sandset
Keyword(s):  
Public Health ◽  
Clinical Trial ◽  
Hiv Prevention ◽  
Hiv Infections ◽  
Vulnerable Groups ◽  
Close Reading ◽  
Trial Protocol ◽  
Hiv Seroconversion ◽  
Exposure Prophylaxis ◽  
The Impact

Pre-exposure prophylaxis (PrEP) (Truvada) is a medication which if taken correctly is almost entirely effective in preventing HIV infection. In regions and countries where it has been widely taken up, HIV seroconversion rates have significantly decreased. Alongside testing and treatment, it offers the very real prospect of ending HIV infections. However, in England, commissioning it has (and still is) a controversial process, where NHS England has repeatedly raised supposed ‘uncertainties’, first legal and then scientific. The same has not happened in Scotland, where PrEP was commissioned to anyone who needed it in April 2017. This article presents a close reading of the IMPACT trial protocol, which we conclude cannot answer the questions it sets out to answer. We then suggest that the uncertainties the trial claims to address are in fact a tool of power which is deployed to strategically ration healthcare; introduce uncertainty about commissioning PrEP; and shift the boundary between individual responsibilities and state responsibilities for public health and HIV prevention. We conclude that all the above constitute an unethical use of clinical trial rhetoric, systematically discriminate against minority and vulnerable groups, and ration healthcare for those who most need it. As such, we call on all academics, clinicians and activists to resist further unethical misuses of clinical trial rhetoric.

scholarly journals Efficacy, Adherence and Side Effects of PrEP for HIV-1 Prevention

2019 ◽  
Vol 11 (4) ◽  
pp. 80
Author(s):  
Wanyi Fang ◽  
Bongani I. Mphoyi ◽  
Dineo R. Motake ◽  
Jianxin Liu ◽  
Wenshuang Li ◽  
...  
Keyword(s):  
Side Effects ◽  
High Risk ◽  
Hiv Prevention ◽  
Hiv Infections ◽  
High Risk Population ◽  
High Adherence ◽  
Prevention Method ◽  
Exposure Prophylaxis ◽  
A Company ◽  
Hiv 1

Each year, approximately two million new HIV infections are reported worldwide. About one decade ago, a company called Gilead Sciences Inc. discovered a new HIV prevention method named as pre-exposure prophylaxis (PrEP). When high adherence was kept among high-risk population, PrEP efficacy could reach as high as 99%. However, the adverse effects have been reported from time to time, including low efficacy in certain cases, adherence difficulties and medicinal side effects. In this review, we would summarize the progress of PrEP since its introduction in order to provide insights for HIV prevention.

scholarly journals A NOVEL OF BIOMEDICAL APPROACH FOR HIV PREVENTION: AN INTEGRATED LITERATURE REVIEW

2017 ◽  
Vol 3 (1) ◽  
pp. 39
Author(s):  
Linlin Lindayani
Keyword(s):  
Human Immunodeficiency Virus ◽  
Hiv Prevention ◽  
Hiv Infections ◽  
Current Evidence ◽  
Cochrane Library ◽  
Post Exposure Prophylaxis ◽  
Prevention Strategies ◽  
Post Exposure ◽  
Immunodeficiency Virus ◽  
Exposure Prophylaxis

ABSTRAKSecara global, jumlah kasus baru terinfeksi Human Immunodeficiency Virus (HIV) sudah mengalami penurunan yang signifikan. Akan tetapi dibeberapa wilayah negara seperti Afrika dan Asia Tenggara, jumlah kasus baru terinfeksi HIV masil mengalami peningkatan. Upaya pencegahan seperti promosi penggunaan kondom, sunat bagi laki-laki, dan skrining HIV sudah diimpementasikan dengan baik. Tetapi, pendekatan tersebut tetap saja tidak menghilangkan seseorang terkena resiko HIV bahkan mungkin untuk pasangan yang hidup dengan penderita HIV malah meningkatan resiko mereka tertular HIV. Sehingga dibutuhkan suatu pendekatan lain yang efekti dan mampu meminimalkan sekecil-kecilnya resiko seseorang tertular HIV. Tujuan dari review ini adalah untuk mengkaji efektifitas pendekatan baru yang dikenal dengan pendekatan biomedik terhadap penurunan resiko tertular HIV. Melalui pencarian secara komprehensif di beberap sumber data seperti PubMed, Embase, Cochrane Library, clinicaltrials.gov, htpn.org, and meta-register dilakukan terutama berfokus pada studi yang diterbitkan dalam Bahasa Inggris pada tahun 2005 sampai 2015. Hasil dari pengkajian tersebut menunjukan bahwa pendekatan biomedik seperti pre-exposure prophylaxis (PrEP) dan post exposure prophylaxis (PEP) merupakan suatu pendekatan yang terbukti efektif dalam menurunkan penularan HIV terutama pada kelompok-kelompok dengan resiko tinggi seperti homoseksual atau heteroseksual. Sehingga, pemerintah Indonesia mungkin sudah bisa melakukan pengkajian yang dalam dan membuat pedoman tatalaksana pencegahan HIV dengan pendekatan ini. ABSTRACTThe number of new cases of Human Immunodeficiency Virus (HIV) infections has decreased significantly worldwide. However, in some regions such as Africa and South East Asian, new HIV infections remain high. Prevention strategies such as promoting condom use, male circumcision, and early HIV detection have been implemented well. However, all those approaches still putting people at high risk of HIV infection. The purpose of this review is to summarize current evidence about biomedical approach as an effective HIV prevention. A comprehensive computerized literature search was conducted using PubMed, Embase, Cochrane Library, clinicaltrials.gov, htpn.org, and meta-register to retrieved relevant literature published from 2005 to 2015 in English to review a current approach for HIV prevention. Biomedical approaches using antiretroviral drugs have shown good efficacy in the prevention of mother-child transmission for post exposure prophylaxis. Recent evidence has also found pre-exposure prophylaxis (PrEP) to be promising in preventing HIV. Both WHO and CDC recommended to integrate PrEP and post exposure prophylaxis for HIV prevention strategies. Health care policy needs to consider the biomedical approach to HIV prevention, especially in Indonesia. Therefore, Indonesia government may start to develop a clinical guideline and deeply assess the possibility to implement this approach in clinical practice.Keywords: biomedical approach, prevention, HIV, treatment

Low awareness and use of post-exposure prophylaxis among adolescents and young adults in South Africa: implications for the prevention of new HIV infections

2020 ◽  
Vol 19 (3) ◽  
pp. 242-248
Author(s):  
Anthony Idowu Ajayi ◽  
Mohammed Sanusi Yusuf ◽  
Elmon Mudefi ◽  
Oladele Vincent Adeniyi ◽  
Ntombana Rala ◽  
...  
Keyword(s):  
South Africa ◽  
Young Adults ◽  
Hiv Infections ◽  
Adolescents And Young Adults ◽  
Post Exposure Prophylaxis ◽  
Post Exposure ◽  
Exposure Prophylaxis
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